The CMS Audit initiative involves deploying advanced technology and expanding the workforce of medical coders to clear a backlog of audits from 2018-2024 and audit all eligible MA contracts going forward.
Analysis highlights substantial estimated overpayments to MA plans and the collaboration with the Department of Health and Human Services Office of Inspector General (HHS-OIG) to recover these funds. The pushback from MA payers and potential impacts on providers may be significant as CMS seeks to ensure accurate billing and protect federal healthcare programs.
CMS rolls out Aggressive Strategy to enhance and Accelerate Medicare Advantage Audits | CMS. (n.d.). https://www.cms.gov/newsroom/press-releases/cms-rolls-out-aggressive-strategy-enhance-and-accelerate-medicare-advantage-audits
Rowan, K. (2025, May 29). Medicare Advantage Audits. The Rowan Report. https://www.therowanreport.com/2025/05/29/medicare-advantage-audits/
Stulick, A., (2025, June 4). Nursing homes welcome CMS audits of Medicare advantage plans amid billions in MA overpayments. Skilled Nursing News. https://skillednursingnews.com/2025/06/nursing-homes-welcome-cms-audits-of-medicare-advantage-plans-amid-billions-in-ma-overpayments/
Healy, A. (2025, May 23). CMS to ratchet up MA audits amid concerns of fraud, waste and abuse. McKnights Home Care. https://www.mcknightshomecare.com/news/cms-to-ratchet-up-ma-audits-amid-concerns-of-fraud-waste-and-abuse/
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